Evidence lacking on mHealth effectiveness in poor countries

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Mobile phone technology is frequently heralded as a solution to many health challenges facing the developing world, but two systematic reviews have found that evidence to back such claims is still largely non-existent.

There is a lack of rigorous studies in low- and middle-income settings — where experts agree that mobile health (mHealth) initiatives have tremendous potential — according to the reviews, led by Caroline Free from the London School of Hygiene & Tropical Medicine, United Kingdom, and published in PLoS Medicine today (15 January).

Most existing evidence on success of mHealth schemes is of poor quality and comes from trials performed in the developed world, they say.

For example, just three out 75 trials that aimed to assess whether mobile technology interventions for healthcare consumers could change health behavior or improve disease management were conducted in developing countries.

And none of the 42 trials of interventions designed to support communication among healthcare providers or between health services and patients were done in the developing world.

Mobile phones are thought to be able, among other things, to help manage disease; facilitate drug adherence in tuberculosis patients; speed up diagnosis of HIV and malaria; monitor outbreaks of polio; take and transfer medical images to doctors; and provide an advice hotline for rural health workers.

Previous studies have found mobile phone text messaging to improve adherence to HIV treatment in Kenya, as well as their failure to do so in Cameroon.

But the new reviews found that for disease management, the only two mHealth applications with sufficient evidence of benefit are ones related to adherence to antiretroviral therapy and smoking cessation.

And while certain interventions designed to support healthcare providers modestly improved aspects of clinical diagnosis and management, others were less successful.

For example, the use of mobile technology–based photographs for diagnosis sometimes resulted in incorrect diagnoses, compared with face-to-face treatment. And text message-based appointment reminders were better than no reminders, but were no better than reminders sent by traditional routes such as telephone or mail.

"Our systematic review shows there is good evidence that text messaging interventions can increase adherence to anti-retroviral medication and can increase smoking cessation," Free, a senior lecturer in epidemiology, said in a press release.

"The effects of mobile phone based interventions appear promising in some other areas, but further high quality trials are required to establish their effects."

The reviews call for additional rigorous tests of mobile health interventions, especially in low- and middle-income settings where the control group of 'standard care' might be very different from the standard care available in high-income countries.